Wednesday, October 28, 2009

"I have good insurance! Why should I pay for somebody else's medical care?"

I hear crap like this everyday. Somehow people really believe this, too.

GET REAL PEOPLE! YOU PAY FOR IT NOW! AND GUESS WHAT? THERE IS NO MODEL OF HEALTH CARE WHERE YOU WON'T!!!

Let's look at this: Mr. Poorsap has no insurance. Maybe he's unemployed. Or an illegal immigrant. Or he's working his ass off, but his job doesn't give him benefits.

Mr. Poorsap has a heart attack. Or gets cancer. Or falls down a manhole. Whatever. He goes to Local ER, and needs to be admitted. Legally, Local Hospital can't turn him away.

He's sick as shit. He needs surgery, maybe more than one. A lot of medications. He has a lot of tests. And a few complications. He's in the hospital for a month before he's finally able to go home.

His bill is $1 million dollars (hypothetical number). There's no way in hell he'll ever be able to pay a significant portion of that.

Local Hospital has to pay the nurses who took care of him, and the companies who sold them medical supplies and drugs to take care of him. They really can't afford to write off that $1 million. So they raise the rates on EVERYONE who comes to the hospital, to help offset the costs of the uninsured.

So they send all these bills to Giant Insurance, Inc., who pays them. Of course, Giant Insurance, Inc. has staff and rent and office supplies to pay for. They need to make-up the money to offset their losses on what the hospital charged them to make up their uninsured patient losses. And so Giant Insurance, Inc. passes the increased costs on to YOU, by raising your premiums.

And multiply this by tens of thousands uninsured Mr. Poorsaps every day, across the country.

Look at this like shoplifting, people: I don't shoplift (well at least not non-Diet Coke items), and I hope you don't shoplift. But somebody does. So if over the course of a year Local Grocery loses $100,000 to shoplifting, they need to make up that loss by increasing their prices. And we ALL pay those when we go grocery shopping.

So regardless of whether you oppose or support the current plans, or voted red or blue, the bottom line is that YOU ALREADY DO, AND ALWAYS WILL, pay for someone else's insurance. The only people who don't are the ones who have no coverage in the first place. Any politician on either side who tells you otherwise is full of shit.

This is a standard model of business (and health care is a business), and has been since the first business opened it's doors a long time ago. You have to make up your losses somewhere.

I have been trying to stay out of the whole fiasco, but it is really hard to watch conservatives and liberals alike misunderstand the basics of health care and how it works.

And these are the people who are actually making the decisions. Terrifying.

No one seems to be even bothering to deal with the root of the problem--healthcare is a commodity. There's only so much of it. You can't fiat more into existence, no matter how many people are knocking at the doors or how many politicians get involved.

Yeah, I did a comparison between current health insurance and a single-payer (governemnt health care) system a while ago on my blog. It's not just paying for others' medical bills that is already happening, almost EVERYTHING people are complaining about in the healthcare overhaul proposals is already happening. My basic answer was, if it's already happening in private care, then we have nothing to lose with government-run healthcare.

I have heard from the same people, in the next sentence, say "Let them die if they can't afford it. Should have planned better." This was not Joe Critter Six Pack, but supposedly weekly church going people. Or they want to pick and chose who gets services. Meth Head with HIV having a heart attack, sucks to be you. Why should my tax dollars be sunk into your dumb ass?

Shoplifting was the perfect analogy. Bravo on taking a complex situation and making it simple. I spent a few decades in hospital finance and couldn't have explained it better. It is frustrating to hear politicians and the news media misrepresent the situtation so often.

Even insurance companies don't pay as much as private patients, though, right? I spent a few hours in an ER, got the bill for $10k. Ouch. $3k just for the CT scan. Luckily, I have fantastic insurance and happily paid my $25 co-pay and my insurance picked up the rest.....or did they? They only paid $1500...and that is all the hospital is ever going to get because they are contracted with insurance company and that is the amount they will pay. Hospital cannot ask me for more than my co-pay. So does the hospital eat $9k or are private pay patients being overcharged to begin with to make up for those who don't pay? It starts to get a bit crazy.

I, for one, am willing to fork over a bit more money so that all can have access to health care that is paid for. Geesh....it's only decent.

Well said, until the shoplifting analogy. Heads up! Some of us are finding ourselves sans medical insurance for the first time in our lives due to job shifting. My perfectly healthy 16 y.o. and husband have both been denied insurance due to asthma. Which has been under control and successfully managed for years. Is my son or husband a thief if they now require emergency care? Rankles a bit, that.

Well..hubby had insurance through his work for over $400 a month, when work slowed down we had to cancel it just to get buy. We don't have a morgage or car payments, we just have basic bills and that 400 was eating up the grocery money. I guess we could have filed for state help, but why when we was making the money to live but the insurance was taking it.

My plan is to..when I get sick, I suffer through. If I have cancer, I won't know. When I die...build a bonfire and well you know.

No expense, carried on to others and no extra burden on my family to buy land to bury me.

Well, whether you meant it or not, Dr, what you said was spot on. Going to a hospital unable to pay for their services is shoplifting. You're using up the limited time and resources of other people with no ability to compensate them for it. It's theft. It doesn't matter how you got to this position. A starving man caught stealing bread is still going to jail for it.

My husband's insurance took us through Mayo getting check ups and at one point the doctor said to me," you have good insurance what does it matter?" Yes, we had good insurance and I had a lot of tests that I didn't know why I was there for them and at the end of our good insurance I still had to pay $15,000 to find out most of what I knew or suspected anyway. We ended up paying for a lot of tests that didn't need to be repeated. So that leaves me without a money cushion to treat my problems. Way to go for "having good insurance!"

"Conservatives" in this debate simultaneously hold the position of free market capitalism (which views the insurance issue in terms of moral hazard)and compassionate concern for the rights of the elderly. Cognitive Dissonance is the discomfort many people feel when considering conflicting beliefs.

My view is that in areas involving the ill, the disabled, the elderly, those in pain, and needy children, compassion should trump. Every time. If that matches your moral teachings, we're together and if it doesn't then you're blood is cold and your heart is stone.

Joe said: "Going to a hospital unable to pay for their services is shoplifting."

So poor people should just curl up and die when they get sick. Who is going to collect the corpses? It'll probably have to be a government agency, funded by your taxes.

"It's theft. It doesn't matter how you got to this position. A starving man caught stealing bread is still going to jail for it."

Sounds like you've seen Les Miserables. Debtor's prison worked so well, didn't it?

The whole concept of social responsibility for others is why we have food pantries (all those freeloaders gotta get grub somewhere) and subsidised care for the poor. Each person has the same theoretical value, and our life or death is not supposed to be determined by our net worth. Compassion is always better than coldness.

We just have to figure out a way for healthcare to be a right, not a priviledge, and fund it in such a way that everyone makes some contribution, however large or small. As Dr. G said, the only people really making out in our current situation are the uninsured, and I'll wager their baseline health is far worse than the average insured person and they'd choose to have insurance in a second if it were affordable.

The fact is, America is in this unique mess alone, and what we have now is not working. So either we cut off all healthcare for the poorest 20% of the population (after all, they can't afford health insurance, so they are worthless human beings who deserve to die anyway), or we rework the system like all those other countries that seem to have their acts together and a much more economical medical care system and healthier population in general.

Joe - I think you forget that a lot of people who go to the hospital DO pay their bills. However, they can't generally afford to pay the bill off all at once so they make monthly payments. Hospitals don't need the money years or decades from now, they need it now. Insurance rates go up anyway.

I was going to comment on your cold comments regarding the uninsured and thieves, but if you don't get it now, it's unlikely you ever will.

I have a couple of radical ideas (well, seemingly so). Let's bring manufacturing jobs and such BACK to the US *and* actually pay our citizens a decent living wage. I'm really sick of competing with India for my salary (which is around 20k/year at the moment and that's all our family of 3 lives on because there are NO jobs up here for Husband, and there have been many applications sent in). If we have jobs and have money, perhaps we can actually afford to purchase health care.

Second, get rid of insurance altogether. I know, that's radical in itself. My reasoning is this: Insurance wasn't designed for the use it's getting now when it was implemented, nor has it adjusted to fit. I'd rather see Insurance Company hands out of my doctor's office. Then the doctor doesn't have to add in their fee and can instead deal directly with the customer (us). No more playing through Insurance Company Hoops for something that's supposed to be simple. Perhaps if for a while, needed tests and scans and all that took a hit on cost (for now, mind you) that would eventually be made back as people found that they could afford an x-ray or a CT scan or an MRI, or blood tests for monitoring that it's not such a burden to get done. Essentially, drop prices a bit to get us to come in and with more paying customers the money is made back. We're supposed to be a capitalist society, we should make use of it. Let the companies that make said things fight for our business, or the doctor's business instead of Big Insurance business. I'm not sure who picks out the needed things for blood testing and scanning and such, but I think you can get where I'm going with this.

Like I said, just my 2 flippin' cents. I'll probably get flamed or slaughtered, but that's how I see it. I'm tired of being the little person, squashed on and all that because of the lousy economy where I am that I barely get paid minimum wage and we have to decide between food and bills because there's no room for anything else.

"My view is that in areas involving the ill, the disabled, the elderly, those in pain, and needy children, compassion should trump. Every time. If that matches your moral teachings, we're together and if it doesn't then you're blood is cold and your heart is stone."

I suppose that the best way to frame my response is to confess that on most days my blood is lukewarm, and my heart, while not quite stone-like, isn't exactly cotton soft.

My issue with your generalizing certain groups (for which compassion should always trump) is that you don't take the question far enough. Is the two pack a day smoker (like my father was before the horror and decay of cancer took his life at the age of 51) at all responsible for their behavior and for their actions, and for their lack of compassion as it relates to others footing the bill for their habits/lifestyles? If society is responsible for providing the ill and pain ridden, compassion (it would have been more accurate for you to have said compensation) what responsibility (if any) do they have to the society they are dependent on?

If a person is ill, but the illness is the result of a lifetime spent enjoying alcohol, food, or drugs in dangerous excess, the question is not as simple as arguing that those of us who are able should provide compassion, but whether the freedom to make choices (regarding how one lives) should come with a well-funded safety net when those choices result in preventable disease/pain/suffering?

Why does your argument feel like an argument that only ONE group of people has any responsibility for those living in pain, or with illness? And so as to be clear, I am not suggesting that every ill person, or person in pain is so due to self-neglect. What I am arguing (and working in health care, I see this every day) is that there are a number of illnesses today that are preventable (or at the very least, manageable) providing one is willing to do what we know to be healthy (e.g., stop smoking, eat better, exercise more etc...)

Ill children, those who are disabled, and the elderly should be more than accounted for, and we should, as a society, work to ensure that people who are suffering from conditions beyond their ability to control and manage are taken care of, and taken care of with every bit of the compassion a giving and caring society can provide.

Compassion works both ways. The compassion I feel for others is genuine and sincere, but altogether easier to find peace with when people practice a modicum of self-compassion.

As Dr. Grumpy rightly points out, a number of people already pay for those who do not pay. To those who truly can't, who are truly suffering situations beyond their means of control, I will gladly extend to them great deal of what I have. But those who drain a system (which would likely be robust enough to handle those who cannot take care of themselves) while living lives built on poor choices, and unhealthy living, should perhaps first address the cause and effect of such lifestyles before going bat-sh*t crazy on those of us who dare to suggest that bad choices often result in regrettable outcomes.

In health care, compassion equals money. And while we'd all be better off with more of the former, that must always be measured against the reality that we have pretty much run out of the latter.

I have several friends in other countries where NHS is the norm and they are very happy. They are also upset that people in the US, who know little to nothing about their government are calling them socialists and communists.

I agree about the shop lifting thing...and for those of you that get mad at the analogy, too bad, is an analogy, not a recrimination.

Part of me understands how people would like to go in for the pay as you go option..cash prices. But, I am afraid that you would end up with MDs/DOs that have similar problems to the veterinary industry. You will have a significant number of people that want care and do not want to pay for it...then you will have no insurance fees to offset that.

This morning, I had someone bring in a cat that was found in the middle of the road last night...they watched it suffer all night, refusing to take it to the emergency clinic for humane euthanasia (FREE). They told my office that they could spend $300. Since the cat was obviously sick (nasty upper respiratory infection) rather than spend that $$ on radiographs, I checked the FIV/FeLV status...it was positive...no sense in spending a very limited budget in trauma care when the cat was obvious suffering from multiple (and non-curable problems). I called the owner and she requested euthanasia...but now says that she wants to make payments that she has $2 to her name. She outright LIED and dumped the cat...theft of services. Now, everyone gets to pay for this. Or should I choose not to pay employees this week, or the water bill, or rent?

As a former Canadian and now Australian I have been very happy with both of these health systems.

Frankly, I am quite happy that I have never experienced an American style health system. From all I have read about it it is in desperate need of some type of reform, whether it be what Obama is seeking, or something different altogether.

>>Part of me understands how people would like to go in for the pay as you go option..cash prices. But, I am afraid that you would end up with MDs/DOs that have similar problems to the veterinary industry. You will have a significant number of people that want care and do not want to pay for it...then you will have no insurance fees to offset that.>>

Most of my veterinary clients can pay for routine healthcare, as well as the occasional minor illness or injury. They run into trouble with major acute (colic requiring abdominal surgery comes to mind) or chronic illness requiring long-term management.

I favor a model of insurance that covers catastrophe, either short- or long-term but does NOT become involved in routine healthcare. This would reduce paperwork, especially for beleaguered primary care docs. I also think it's important to re-introduce Americans to the actual cost of healthcare... not "free" (e.g., covered by insurance) or artificially inflated (what those without insurance are billed, since one can't bargain as an individual).

For example: I pay about $4000/year for an individual insurance policy with the lowest deductible I could find ($1000). I'm 40 with no significant health issues. In general, I visit a physician about once a year. I don't agree to screening tests I don't need (cholesterol level in a skinny athlete my age with no family history... not too hard to turn that down) and I certainly don't request extra tests not indicated for my age (colonoscopy, again with no family history). My "real" annual bill, if I were to pay directly, would probably be around $500-600 (exam and indicated tests). Honestly, I'd prefer to pay the physician directly and pay another $3000 (or whatever) to the insurance company for major medical/surgical coverage IF the insurance company actually covered me in the event of catastrophe (which, sadly, has not proved to be the case).

Health care costs money. I think Americans are scared of change partly because they don't know how much care really costs. Insurance companies have become wealthy and powerful playing on this fear of the unknown.

>>They told my office that they could spend $300. Since the cat was obviously sick (nasty upper respiratory infection) rather than spend that $$ on radiographs, I checked the FIV/FeLV status...it was positive...no sense in spending a very limited budget in trauma care when the cat was obvious suffering from multiple (and non-curable problems). I called the owner and she requested euthanasia...>>

This is the kind of thinking (minus the euthanasia, of course!) we should have more of in human medicine.

Honestly, if I had end-stage COPD, I wouldn't want a mammogram (true story: this was offered to one of my elderly relatives, who had end-stage Alzheimer's in addition to the COPD. We said "no, thanks").

>>...but now says that she wants to make payments that she has $2 to her name. She outright LIED and dumped the cat...theft of services. Now, everyone gets to pay for this. Or should I choose not to pay employees this week, or the water bill, or rent?>>

Yeah, I HATE those clients. They're thieves. And we'll continue to have them in human medicine, regardless of the model of payment. Honestly, I think human physicians would become as adept as we are at minimizing the damage in non-emergent situations. At my dentist's office, I pre-pay; physicians could easily do the same. For emergencies, well, we all took oaths (physicians and veterinarians).

I admire physicians. I have compassion for my patients because they're all innocent. I don't know how I'd feel about treating lying, worthless, human wastes of space. At least I can surreptitiously whisper to my patient: "your owner is a PITA, but I'm going to take the best care of you I can."

To say we all pay for treatment of people who do not have insurance is only half the story. We are also making up for the shortfall from Medicare and Medicaid. The shortfall (meaning they do not come close to covering the real cost of treatment) from these programs have much more of an impact on cost-shifting than do the uninsured. The reason is sheer volume. Short-term acute care hospitals have government payor volumes of somewhere between 35% to 60% of their total discharges. Medicare pays better than Medicaid and is still paying somewhere around 50% of cost--depending on your region of the country. Medicaid is simply a pathetic payor wherever you go. In some states Medicaid may pay 10% of charges. It is an entitlement that is breaking many state budgets, though. Anyhow...I digress...back to the topic of the uninsured. The percentage of uninsured patients hospitals see varies widely but a good round number is around 15%. Here again, in Detroit it will be more than in Salt Lake City. You do the math. If the government payors even paid for the cost of treatment, cost shifting would be reduced significantly. Now, lets imagine that there are no commercially insured patients to shift the cost of the government payor and uninsured shortfall to---everyone's bill is paid by the government. Everyone's bill is paid at 50% of cost. Not many hospitals would survive and not many good doctors would accept such poor reimbursement.

I don't want to pay for some 50 year old guy's heart attack when he's been a 2-servings-of-meat-eater for his entire life. I won't subsidize his cholesterol medication either. He's making his choice to destroy his own health when he knows that a diet free of animal products is the healthiest option.

I refuse to pay for the healthcare of anyone who drives a motor vehicle and crashes. I don't care if it's their fault or not. You choose to pilot a 2 ton machine around other 2 ton machines, I don't want to pay for your stupidity. What's that? You can't survive in your rural environment without a car? You should have thought about that before!

I mean really, where do we draw the line? Smoking, drinking, being overweight....what about non-teeth-brushers or people who refuse to get yearly physicals? Office-dwellers who don't get 60 minutes of vigorous exercise every day? Just like we don't get to choose where our tax money goes, we shouldn't get to pick and choose whose medical care we allow. And I sure as heck and not going to sit by and watch a smoker or an obese person die, no matter WHAT they have chosen to do with their life.

Yo, annon you need to get out more! Thinking of a meat eaters heart attack? I'll take that one, Think again, I'm talking about an IV drug abuser (unemployed at 28) who frequently shows up at the ER with problems associated with his drug use-anything from injuries due to a "fall" to an infected buttock--yeah, when was the last time you had an infection in your right glute because of using a dirty needle, and then became septic? Never mind that he rips off my neighborhood as well.

Want more? A dialysis patient who blows off his regular run on Friday then eats strawberries, guess what? You and I pay for a weekend hospital stay 'cuz he didn't want to go and really, really wanted those strawberries!

Guy didn't take his meds (for high blood pressure) 'cuz they made them feel funny (did not check with MD first)...all of a sudden, why can't I use my right side?

Getting back to the "shared costs" thing again: it's worth pointing out that in most countries where a public health system is an option, there's usually a private health insurance system running in parallel. People who can afford to do so will usually get private health insurance (in Australia, where I am, private health insurers cover a lot of preventative medical treatments, like quit smoking classes, health club memberships, relaxation classes, yoga, etc) just as a way of covering those little extras. Private health insurers here cover things like glasses (the frames, which are the expensive bit, not just the lenses, like Medicare), dental work (largely not covered by Medicare), prosthetics and mobility aids (giving a wider range of options to people who require such things), physiotherapy, naturopathy, ambulance cover and similar. The other thing private health insurance is useful for is getting elective surgery (rather than waiting on the Medicare list), choosing which surgeon or hospital you're using, or even just getting a single room rather than being on a multi-bed ward.

Over here, the cost sharing provided by the tax-underwritten universal health cover provides the basic level of cover to everyone, then the private system is available to provide more options. Yes, my taxes go to paying for the cost of some person who started smoking as a teenager and hasn't stopped yet (like my still-healthy mother). My taxes also go toward the cost of treating the hole-in-the-heart of a baby whose only "crime" was to be born (like my cousin). They go toward the cost of making medications for childhood conditions affordable (such as the Ventolin another cousin needed for her athsma, and the various penicillin dosages I was given for my string of middle ear infections as a kid) and medications for chronic conditions (like my hypothyroidism and depression, and my partner's type 2 diabetes) available at a reasonable price as well. My taxes go toward the cost of making healthcare in Australia a morally neutral thing - illness and injury happen to the deserving and the undeserving alike, after all.

And, if Mr Poorsap did work, he can't work anymore. So, his kids have less of everything, he goes on disability, and we don't get the taxes we would have gotten off him. If his hernia or whatever had been fixed early, or his cancer had bee picked up at a routine physical, he would have likely had years more productivity and contribution to economy. Kind of like the large mass of my patients who have no dental care, get abscesses, then cardiac disease, then spend a boat load of time in the hospital getting new heart valves, or neurosurgery for the abscess that tunneled into their brain, or both, like one nice guy who used to paint houses and take nice care of his family. Now his family takes care of him, except they have no money and ( long description of heartbreaking consequences) yup, we as a society saved a lot of money on that one. Those dental cleanings should not be publicly paid for, nope.Not going to pay for someones medical care....oh, wait.

only an american can say with a straight face that he is refusing to pay for other peoples health care. It demonstrates your education system in action that more than half your population are unable to use any critical thinking skills.it's a joy to know you have nuclear weapons.Only an American can say they refuse a public option at the same time they are cashing their medicare checks, too stupid to know medicare/medicaid/veterans healthcare are all PUBLIC options run by the government but now suddenly the government is too dumb to run a public option.Every second that goes by americans drop 10 more IQ points. By 2012 you should be ready to elect Dick Cheney as your new President with Palin as Secretary of State.I'd advise that any of you that retain any part of your IQ get the hell out now before the right wing crazed born agains trigger the apocalypse they are so desperately dreaming about.Forget about health care reform, it will never happen in the US even if Obama threatens war on the insurance companies. The right wing doesn't want it and the left are way too scared of them to challenge them.Cheney still pulls the strings that's why the banks got paid and no one got arrested, that's why banks are allowed to steal peoples homes without a whisper from the government, it's why health care will never get more than lip service and maybe, just maybe one law will get passed that will jack up your rates so high you will never be able to pay for them. The law that says insurance companies can't refuse anyone and can't dump high risk.Get out while the rest of us are still allowing immigration...

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This blog is entirely for entertainment purposes. All posts about patients may be fictional, or be my experience, or were submitted by a reader, or any combination of the above. Factual statements may or may not be accurate.

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